Comprehensive primary health care and non-communicable diseases management: a case study of El Salvador

Abstract

Background One of today’s greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders’ perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. Methods A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. Results The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. Conclusions The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.

The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study

“… “We work in a network; this means that each Community Family Health teams are connected with the Community Health team specialised within the area as well as with community organisations in order to properly approach the real needs of the population”. (Health provider, interview; Jimenez Carrillo et al, 2020 , p.6) …”

“…It allows us to give each other advice and learn to survive in the best way with a specific chronic health problem …“. (NCD patient, interview; Jimenez Carrillo et al, 2020 , p.13)…”

“…They always try to assure us that we understand everything correctly ” . (NCD patient, interview; Jimenez Carrillo et al, 2020 , p.10) “I explain them [patients] the medications and their schedules. I indicate how they are going to take them.…”

“…They always try to assure us that we understand everything correctly ” . (NCD patient, interview; Jimenez Carrillo et al, 2020 , p.10)…”

Identifying opportunities to engage communities with social mobilisation activities to tackle NCDs in El Salvador in the context of the global COVID-19 pandemic

“…Previous studies have explored community and health staff perceptions on NCD management in primary care in El Salvador following the CHS reform [ 8 ]. Evidence from these studies suggests that the health system has strengthened its comprehensive approach to NCDs with preventative and community-based strategies.…”